Embargo lifted at 9.01am AEST Wed 25 April 2012

NEWS BRIEFING:  The dangers of youth – a Lancet series on adolescent health

ONLINE BRIEFING – Tue 24 April at 9.30am AEST

There are around 4.8 million adolescents (those aged 10-24 years) in Australia today, comprising around a fifth of our total population. However, new research is beginning to suggest that despite how invincible teenagers feel, when it comes to health, these are not the ‘best days of our lives’.

While half a century ago it was common for young people to settle down and have a family in their early 20s, today these milestones are delayed and the window of risk for adolescent behaviour has substantially increased.

Facebook and Twitter, along with globalisation, and urbanisation have changed traditional family and community influences. For many adolescents, modern-day youth culture now also includes fast-food, binge drinking, cyber bullying and ‘sexting’. Yet despite this being a period of high risk, there is little focus on the specific health challenges faced by adolescents while they are actually adolescents.

The 45^th Session of the United Nations Commission on Population Development takes place in New York from April 23-27. To coincide with this, The Lancet journal is launching a special series on adolescent health. Two of the Australian scientists who contributed to this series will stay up late in New York to brief Australian journalists on the key findings and how Australia fares.

SPEAKERS:

• Professor Susan Sawyer, Director of the Centre of Adolescent Health at Murdoch Children’s Research Institute, and University of Melbourne | Susan’s Powerpoint
• Professor George Patton, Director of Research at the Centre of Adolescent Health at Murdoch Children’s Research Institute, and University of Melbourne | George’s powerpoint

BRIEFING DETAILS:

DATE: Tuesday 24 April
START TIME: 9.30am AEST
DURATION: 35 min
VENUE: Online  |   A recording of the full briefing is now available here

For further information, please contact the AusSMC on 08 7120 8666 or email us.

NB:  The AusSMC generally runs two different types of media briefings:
NEWS BRIEFINGS – Where new research or data will be released as part of the briefing
BACKGROUND BRIEFINGS – Where experts discuss an issue which is in the news or an issue we consider newsworthy, but no new research or data is being released 

Swedish and American authors say a new technique involving the use of an artificial scaffold into which a patient’s own stem cells are inserted, turning it into a fully functional organ, could offer a potential solution to the donor shortage crisis. The review article is one of two papers in a Lancet stem cell series. Below Australian experts respond.

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Wendy Rogers is Professor of Clinical Ethics in Department of Philosophy and the Australian School of Advanced Medicine at Macquarie University

“The promise of stem-cell engineered whole organs and complex tissue is highly attractive on a number of fronts. Not least is the potential to side-step the complex ethical issues associated with organ donation and transplantation from living and cadaveric donors. While Caplan and colleagues are right to draw attention to the current ethical challenges of developing the technology, wider issues are also relevant. This technology has the capacity to alter the landscape of organ transplantation. It won’t be possible to know whether engineered organs are better or worse than transplants from other (living or dead) humans for many years, so that we will stay in the “experimental” phase for a long time until long-term follow up trials have established safety and effectiveness profiles. This creates the possibility that there may be pressure for people who are refused conventional transplants to volunteer for or accept engineered organs. Second, if it seems that life with engineered organs is better (which it obviously has the potential to be, given that no immunosuppression will be necessary) then we may get a two-tier system in which those who can afford engineered organs will get them while others accept organs retrieved from humans.

As with all technological breakthroughs, a focus on innovative treatment takes our attention away from both prevention, and patterns of disease and their underlying causes, so it is important that the science does not dazzle us so that we lose track of, for example, programs to prevent kidney or liver disease.

Finally, there is a great opportunity to perform the necessary research and to make staged introduction of engineered organs an exemplar for the introduction of innovative procedures. To achieve this will require genuine cooperation, transparency, a willingness to act for the greater good, and procedural oversight including registers so that all engineered organs are identified and tracked.”

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Professor Martin Pera is Program Head of Stem Cells Australia and Chair of Stem Cell Sciences at the University of Melbourne

“This article in The Lancet provides an overview of recent advances in rebuilding tissues and organs for transplantation therapy. The authors focus on an approach that exploits nature’s own design templates. Cells for transplantation are seeded onto constructs made not from artificial materials, but from donor or animal derived tissues or organs that have been stripped of any cellular content to leave behind the extracellular matrix, the rich and complex scaffold on which organs in the body are constructed. This decellularized extracellular matrix provides an appropriately shaped structure to which the cells can attach, as well as signals which guide their growth, maturation and integration into the new organ.

The results using this natural approach to tissue engineering are sometimes quite dramatic, achieving significant reconstruction of the key features of the native tissue by grafted cells. However, in order to avoid the use of animal products, and to get around the shortage of human donor tissue, it is likely that future research will focus on mimicking the natural templates with synthetic materials. Moreover, even with the perfect template, an abundant source of the appropriate cells to seed the scaffold is an essential component to organ reconstruction. Future studies will seek to identify the optimal source of cells for each clinical application, whether from patient tissue or stem cell cultures grown in the laboratory.”

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* Engineered whole organs and complex tissues, Macchiarini et al., The Lancet, Vol 379, 2012

[*Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial, Nijhof et al, The Lancet, Published online March 1, 2012]
Feel free to use these quotes in your stories.   If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Rosanne Coutts is an Accredited Exercise Physiologist and  Lecturer in Sport and Exercise Psychology at Southern Cross University

“These results are very encouraging and again demonstrate the importance of the psychological aspects within treatment processes. By using the internet, which adolescents are very familiar with, they have met them ‘where they live’. The patients also seemed fairly involved in what they did, it was quite self-driven, putting patients back in charge of their own recovery. Further detail about the actual physical activity conducted in both groups would be of interest and would assist with understanding any physiological changes that had also occurred. The study also relied on, self-report, however even with consideration for some self-reporting bias the school attendance is a clear indicator of levels of recovery.  Previous studies report a good prognosis for adolescents and this study again supports this.”

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Two of the BSJM paper’s authors respond to The Lancet paper and discuss how the two studies relate to one another.

*Television viewing time and reduced life expectancy: a life table analysis, Veerman et al., British Journal of Sports Medicine, DOI:10.1136/bjsm.2011.085662, August 16, 2011 (Embargo lifted at 8.30am AEST Tuesday August 16)

** Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study, Wen, Wai et al., The Lancet, DOI:10.1016/S0140-6736(11)60749-6, August 16, 2011 (Embargo lifted at 9am AEST Tuesday August 16)

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like copies of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Neville Owen is Head of the Behavioural Epidemiology Laboratory at Baker IDI Heart and Diabetes Institute, Melbourne

“These are intriguing findings. However, in many countries these days, leisure time physical activity is a rare commodity in adult populations. In Australia, the USA and Canada, for example, leisure-time physical activity drops off rapidly from early middle age and is simply not on the agenda for a high proportion of the population. In these chronically-inactive populations, much of the problems that we are seeing can be attributed to people being stuck for long periods of time in front of screens for work and entertainment, and stuck in automobiles to get to and from work in other places. Thus, there is very little functional physical activity in people’s lives, and many adults will sit for 10 or 12 hours a day. The real action is in promoting physically-active transport and a range of initiatives that will help people to reduce the vast amounts of time that they spend sitting.”

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Associate Professor David Dunstan is Head of the Physical Activity Laboratory in the Division of Metabolism and Obesity at Baker IDI Heart and Diabetes Institute, Melbourne

“This study is one of the largest of its kind, with over 400,000 individuals and the follow-up period is also extensive. The results confirm the well-accepted thinking that the greatest gains are made from taking a person who is inactive, to doing some form of activity. The relative gain is much lower by moving people who are already active to doing more activity.

It is important to acknowledge that the authors focused ONLY on leisure-time activity. Thus, it doesn’t include other key contexts in which activity/sedentary time is likely to occur e.g. workplaces, transportation. It is well known that leisure time should not be viewed as being reflective of total activity, since for most individuals the volume of time spent in workplaces and in transportation far outweighs leisure time. This means that some pretty large pieces of the jigsaw are not covered in this research.

The study comes with the inherent problem that has existed in this type of work for decades – i.e. the use of self-reported measures having problems with accuracy and over-reporting. Also, recent studies that have used accelerometers to objectively measure physical activity and sedentary time have shown that people can be active during their leisure time but then also spend large chunks of time sitting – including watching television. Indeed, in our studies, we have shown that TV viewing is very poorly correlated with participation in moderate-vigorous activity – that is, people can watch a lot of TV but also be physically active during their leisure time.

As the authors state in their paper  ‘we cannot attribute the recorded health outcomes entirely to physical activity’, which is a bit of a given with these types of analyses. However, what should be pointed out here is that even in a person who has four hours of available leisure time, if they do achieve their 15 minutes of physical activity, this still leaves 3.75 hours of ‘non-exercise’ time. For many people, this is invariably spent in sedentary (sitting) behaviour – such as watching TV. Thus, too little exercise AND too much sitting are both major public health problems in their own right. This is where our papers are complementary.

Intriguingly, understanding the Taiwanese culture/societal structure could be important in this context. It is possible that opportunities to not sit so much and engage in incidental activities, like light walking around the house, still exist whereas in other populations, this movement has essentially been engineered out of our lives. There are many examples where the chair has replaced the legs!

The general message from both pieces of work should be to encourage people to ‘Stand Up, Sit Less and Move More’.”

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Feel free to use these quotes in your stories. Any further comments will be posted on here . If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Norman R Saunders is a Professorial Fellow in Neuroscience at the University of Melbourne

“In a field full of hype, hyperbole and unfulfilled promises, the report by Susan Harkema, Reggie Edgerton and their colleagues in The Lancet stands out as a milestone achievement that holds serious promise of an intervention which could eventually help a significant number of people who have had the misfortune to have suffered a spinal cord injury. As the authors point out, what they have shown was only in a single patient. It will be some time before it is clear which spinal injury patients may benefit and replication will be important to verify these initial findings.

It has been known from the work of the English Physiologist Charles Sherrington early in the last century that the spinal cord contains neural circuits (rhythm generators) that can produce alternating limb movements in the absence of any nerve connections from the brain. Reggie Edgerton is one of a small number of neuroscientists to have realized that studies of these local circuits in spinal injury might lead to insights that could lead to effective treatments for this appalling condition. They have used local electrical stimulation applied over the dura mater that surrounds the spinal cord to activate local neural activity in the spinal cord below the level of the lesion.

There are three striking outcomes. (i) In the initial stages of the study electrical stimulation generated sufficient nerve impulse output from the spinal cord for the patient to be able to stand and with stimulation to the limbs from being supported over a treadmill and assistance from therapists, the patient was able to make walking movements. (ii) After several months of treatment the patient recovered some voluntary movements in the lower limb and also (iii) some recovery of bladder control, sexual function and temperature control. This last outcome may seem less dramatic than the other two, but surveys of patients with spinal cord injury have consistently shown that many rate problems of bowel, bladder and sexual function as more important to have help with than being able to walk.”

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Dr Bryce Vissel is Head of Research into Neurodegenerative Diseases at The Garvan Institute

“Susan Harkema and her colleagues report an extraordinary finding with significance for the spinal injury community as a whole. By implanting electrodes and applying electrical stimulation to the spinal cord below the injury, Dr Harkema was able to initiate both weight bearing and some movements in a patient with severe spinal cord injury. This was achieved without repairing the spinal cord. The work, while still very preliminary, provides both practical and scientific implications. It provides a potential means to assist people who have suffered the debilitating consequences of an injury. It also teaches us a great deal about the spinal cord’s ability to regulate movement without the brain’s input.

As with all research, it is too early to say how broadly applicable this will be to people with spinal cord injury more generally and how extensive the benefit will be. There is a lot of work to do. However the exciting result shows us just how critical research is. Research is rapidly leading to progress and it is uncovering possibilities. It is increasingly possible to feel optimism for the future for people with debilitating injuries.”

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Prof Alan Harvey is Winthrop Professor of Anatomy and Human Biology, at The University of Western Australia

 ”This is a very important and exciting new patient report, but in a way it’s not actually surprising. It has been known for a long time that some types of animal with a completely disconnected spinal cord can still be placed on a treadmill and made to reflexly walk, and their walking speed alters if the treadmill speeds up, because the animal is taking advantage of complex circuitry that already exists within the spinal cord as part of a sensory-motor arc.

 There was the famous case of the man in the UK who lost all of his dorsal root ganglia and so received no sensory input, so no information about where his limbs were. Amazingly, he learned to walk by looking at his feet and thus giving himself alternative sensory information. His motor output was fine. The example today shows that by using electrical stimulation to open the spinal sensory-motor loops it is possible to activate the pattern generators that help control standing and stepping.

Normal people walk without thinking about moving one foot in front of the other, and the next test now might be to see whether this motor function can be linked to a voluntary desire to walk so that someone can think about when to walk and when to stand still, and then the body responds accordingly. However, this is likely to be a long way off.”

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